Irregular or missed periods: when should you see a gynaecologist?

• In adults, a typical cycle lasts 21 to 35 days, with bleeding for up to 7 days.
• A cycle length that changes by more than 7 to 9 days from month to month is considered irregular.
• Stress, weight change, intense exercise, and illness are common temporary causes.
• PCOS affects about 1 in 10 women in India, according to a pooled analysis of Indian studies, and is a leading cause of irregular periods.
• Most causes can be found with a medical history, an examination, blood tests, and sometimes an ultrasound.

Most adult cycles last between 21 and 35 days, counted from the first day of one period to the first day of the next. Bleeding usually lasts up to seven days. A healthy cycle doesn't need to start on the same date each month; small changes are normal.

Periods are generally considered irregular in any of these cases:

• Cycles are repeatedly shorter than 21 days or longer than 35 days
• Bleeding lasts longer than seven days
• Cycle length varies by more than 7 to 9 days

In the first few years after periods start, and in the years before menopause, cycles are often less regular.

One early or late period is rarely a concern. What matters is a pattern that repeats over several cycles.

Temporary and lifestyle triggers

• High stress or major life changes
• Significant weight loss or gain
• Intense exercise or eating too little
• Travel, illness or disrupted sleep
• Starting, stopping or changing hormonal contraception
• Breastfeeding or the months after childbirth

Periods often return to normal within a few cycles once the trigger settles.

Medical conditions

• Metabolic Ovarian Syndrome (PMOS): a hormonal condition that affects ovulation, often with acne, excess hair growth, or weight gain
• Thyroid disorders: both an underactive and an overactive thyroid can change your cycle
• High prolactin: a hormone imbalance that can stop periods and sometimes cause milky nipple discharge
• Perimenopause: hormonal changes, usually in the 40s, that make cycles less predictable
• Fibroids or polyps: non-cancerous growths that can cause heavy or irregular bleeding
• Primary ovarian insufficiency: loss of normal ovarian function before age 40

A gynaecologist visit is worthwhile in any of these situations:

• You've missed three periods in a row and aren't pregnant
• Your periods have been irregular for more than three months
• You bleed between periods or after sex
• Periods are very heavy, painful or last longer than seven days
• Irregular periods come with acne, excess hair growth or unexplained weight change
• Your periods haven't started by age 15
• You're under 45 and your periods have stopped
• You have any bleeding after menopause

Early assessment helps find conditions such as PCOS, thyroid disorders or fibroids sooner, when they're easier to manage.

Treatment depends on the cause.

• Lifestyle changes: managing stress, reaching a healthy weight, and balancing exercise with enough food
• Hormonal treatment: contraceptive pills or progesterone to regulate cycles or reduce heavy bleeding
• Treating the underlying condition: thyroid medicine, PCOS care, or treatment for fibroids or polyps
• Monitoring: for perimenopause, when symptoms are mild

Treatment usually starts with simple steps, adding more targeted options if needed.

At Visit Clinic in Marathahalli, you can see a gynaecologist, take recommended tests, and follow up in one place.

• Gynaecologist consultations among 20+ specialities
• Online doctor consultation through the Visit app for non-urgent cycle concerns

1. Track your cycle length, flow and pain for two to three months.
2. Take a pregnancy test if you've missed a period and could be pregnant.
3. Get emergency care for severe one-sided pain, fainting or very heavy bleeding.
4. For ongoing irregular periods, book a gynaecologist consultation at Visit Clinic.
5. Bring your cycle notes and a list of medicines to the appointment.

Disclaimer: This article is for general information only and is not a substitute for medical advice.